Alterations in Hematological/Immune Flashcards
Erythrocytes
RBCs
Leukocytes
WBCs
Polycythemia
An abnormally high number of RBCs
Thrombocytes
Platelets
Clotting Cascade
The series of steps that occur during the formation of a blood clot after injury by activating a cascade of proteins called clotting factors
Anemia
Low number of RBCs
Hemoglobin
The protein contained in RBCs that is responsible for delivery of oxygen to the tissues
Hematocrit
Volume % of RBCs in the blood
Pediatric Hematologic Considerations
Production of blood cells begins at ~8 weeks in-utero
Fetus receives iron (Fe) through the placenta from mom
Erythropoietin is derived primarily from the liver in the fetus, kidneys take over after birth
Three types of normal hemoglobin present at birth
- Adult (Hgb A and A2)- present in-utero and predominate around ~2 months after birth
- Hgb F- predominate at 8wks GA, decreases to ~70% by birth & disappears by 6-12 months
Iron-Deficiency Anemia
Most common nutritional disorder in the world, prevalence higher in developing countries
- Disproportionally impacts children and pregnant women
Occurs when the body does not have enough Fe to produce Hgb
Risk Factors for Iron-Deficiency Anemia
Prematurity or LBW
Exposure to lead
Exclusive breast-feeding beyond 4 months of age w/out Fe supplementation
Cow’s milk without adequate Fe intake
Low socioeconomic status
Recent immigration from developing country
Use of meds that interferes with Fe absorption (antacids)
Etiology of Iron-Deficiency Anemia
Dietary lack
Impaired absorption
Increased requirement
Chronic blood loss
Diagnostic Criteria for Iron-Deficiency Anemia
For children 6 months to <5 years:
- Ferritin <15 micrograms/Land
- Hemoglobin <11 g/dL (for children 0.5 to 5 years)
For children 5 to <12 years:
- Ferritin <15 micrograms/Land
- Hemoglobin <11.5 g/dL (for children 5 to 12 years
Clinical Manifestations of Iron-Deficiency Anemia
Usually no sx in mild cases, can cause growth retardation in prolonged (chronic) cases
Reported symptoms may include: irritability, headache, weakness, shortness of breath, dizziness, pallor and fatigue
Koilonychia: Spoon-shaped dents in nails
Less common sx include: pica, muscle weakness, unsteady gait, difficulty feeding
Assessment of Iron-Deficiency Anemia
Inspect mucous membranes and skin for pallor
Assess for spooning of the nails
Auscultate for flow murmur
Assess spleen for splenomegaly
Nursing Interventions for Iron-Deficiency Anemia
Goal is to determine and treat underlying cause
Encourage breast-feeding mothers to increase their daily intake of Fe
- If formula-fed encourage Fe fortified formula
Cow’s milk in intake for children >1 year of age should be limited to less than 24oz/day
- Cow’s milk makes it harder for the body to absorb iron
- Prevents digestive tract from absorbing iron from foods
Educate, educate, educate! Collaborative care with caregivers
Avoid NSAIDs, treat aches/pains with Tylenol
- NSAIDS can cause GI bleeding and irritation as well as iron loss
Recommend Fe supplementation for infants beginning at 4 months of age
- ~3-6mg/kg/day of iron supplementation, best to take 1hr before meal to enhance absorption
- Warn caregivers that stools may be black in color
- Constipation may occur: increase fluid intake and fiber, may need stool softener
- Place drops behind teeth (give with straw in older children), as can cause staining
Heme Sources of Iron
Beef
Chicken liver
Chicken
Turkey
Crab
Tuna
Halibut
Pork
Shrimp
Non-Heme Sources of Iron
Iron-fortified cereals & oatmeals
Soybeans
Lentils
Kidney & lima beans
Black-eyed peas
Navy, black pinto beans
Spinach
Sickle Cell Disease